Value of an Oral Elemental Diet During Induction Therapy of Ulcerative Colitis with Infliximab: a Pilot Study

approved for the nutritional management of patients with pancreatic disease [1, 2]. Nutrition therapy with elemental diets has been reported to significantly reduce mucosal inflammation and improve clinical and endoscopic disease activity and mucosal cytokine levels when used as a first-line therapy of Crohn’s disease [3, 4]. Prior studies with enterally administered elemental diets have also reported histologic improvement in patients with eosinophilic esophagitis [5], a reduction of symptoms in patients with chronic pouchitis [6], and reduced diarrhea in gastrostomyfed patients [7]. The role of elemental diets in the management of ulcerative colitis remains unclear [6, 8]. Axelsson et al. previously reported remission of disease activity in 44% of 34 patients with inflammatory bowel diseases (23 patients with ulcerative colitis and 11 patients with Crohn’s disease) associated with the use of an elemental diet administered as a tube feeding. Six of 13 patients with ulcerative colitis treated with elemental diet remained well for 7-28 months [9]. Induction therapy using infliximab in ulcerative colitis patients has been associated with frequent defecation and a reduction in serum albumin levels [10, 11]. We hypothesized that oral ingestion of an elemental diet during induction therapy with infliximab for ulcerative colitis would reduce the need for intravenous therapy and result in a reduction in diarrhea. The aim of this pilot study was to evaluate the effects of oral administration of an elemental diet during induction therapy with infliximab in patients with active ulcerative colitis. Method Patients Consecutive patients with moderate to severe ulcerative colitis receiving induction therapy using infliximab at the Showa Inan General Hospital were enrolled from January 2011 to March 2016. The first group of patients (from January 2011 to August 2013) received traditional induction therapy plus peripheral intravenous fluid therapy alone (IV group). The subsequent group received induction therapy plus the orally administered Abstract